Language as a Way of Returning Power

When I began Prose for Patients, I thought of storytelling as a way to preserve someone’s life beyond the limits of diagnosis. A person sits across from us, or appears on a screen, and tells us what they want remembered: the illness, the uncertainty, the family, the art, the anger, the years of being dismissed, or sometimes everything except the disease. We listen. We write. We revise until the participant can say, this is me.

In my conversation with Dr. Awdish, I was reminded that this work is not only about preserving voice. It is also about power.
She described writing about her own experience as a patient as clarifying. There were things she saw from the patient side of medicine that she believed others might understand differently if they could experience them through literature. She was not interested in simply telling readers what to think. She wanted the writing to allow readers to arrive at a new way of seeing, especially around the language and behaviors medicine uses almost thoughtlessly.

That idea stayed with me because it names one of the deepest hopes of Prose for Patients. A story should not only make someone feel sad or inspired. It should change what they notice. It should make the invisible visible: the casual phrase that closes down a conversation, the medical efficiency that erases fear, the clinical explanation that never asks whether the patient understands, the diagnosis that offers an answer but also creates an aftershock.

Dr. Awdish spoke about the difference between In Shock and Aftershock. The first book, she explained, carried an agenda and a physicianly authorial voice. It had something of medicine’s idealized view of itself: bodies are acted upon, brokenness is repaired, the arc bends toward redemption. But illness did not remain that clean. A later cancer diagnosis made healing feel messier and more recursive. She described healing as returning to the same places again and again with different tools and lenses. That felt like one of the most important lessons of our conversation.

A patient story is not a fixed object. It is not captured once and completed forever. It changes as the person changes. Before diagnosis, the story may be uncertainty. After diagnosis, it may become relief, grief, anger, or shock. During treatment, it may become endurance. Later, it may become advocacy, memory, or something more complicated than any of those words. This is why I have been thinking about longitudinal storytelling through Prose for Patients: not just asking someone for “their story,” but returning later to ask what still feels true, what now feels incomplete, and what the story has become.

Dr. Awdish also described her work teaching communication through a curriculum called CLEAR, which uses improvisational actors to help physicians practice difficult conversations: serious news, death and dying, conflict, and other moments medicine often handles poorly. Over time, the curriculum grew from one department’s trainees into an institutional requirement. That growth mattered to me because it showed that humanistic work does not have to remain soft, optional, or symbolic. It can become structure. It can become training. It can become part of how an institution teaches its people to speak.

But the part of our conversation that most directly challenged me was her framing of language as a way to redistribute power back to patients. She gave a simple example from the ICU. A clinician can say, “Your mother needs to be intubated,” which leaves little room for values, questions, or shared understanding. Or the clinician can say, “Your mother’s breathing is getting worse. Can we talk about what we might be able to do?” The clinical situation may be the same, but the second version opens space. It invites conversation. It gives the family a place inside the decision rather than making them witnesses to a declaration.

That is the kind of difference Prose for Patients has to pay attention to. We often talk about elevating patient voice, but that cannot only mean collecting stories and sharing them. It means noticing the conditions that make voice possible. It means asking who controls the conversation, who shapes the final artifact, who decides what is shared, and whether the participant leaves the process feeling more represented or more exposed.

Dr. Awdish was clear that both things must happen: physician power must be examined, and patient power must be elevated. She pointed toward patient activation frameworks that teach patients how to advocate for themselves and escalate concerns. Her own work focuses more on the physician side: how clinicians speak, how they listen, and how they can stop hoarding power through language. For Prose for Patients, the lesson is that storytelling can sit between those two worlds. It can help patients name what matters, and it can help clinicians learn how much is lost when they do not ask.

We also talked about medical education. Dr. Awdish said she worries less about students than about the systems that break them. Many students enter medicine with idealism, empathy, and a desire to understand structural determinants of health, power, and communication. But when they enter clinical environments built around efficiency, throughput, and finance, those values can be pushed aside. The danger is not that students do not care. The danger is that the system teaches them to care in silence, then punishes them for trying to practice differently.

Her advice was to maintain a sense of purpose. Medicine will constantly define efficiency in narrow ways: how quickly a patient can be seen, how quickly an encounter can end, how quickly the system can move forward. But she offered a different definition. Efficient care should mean that the patient felt heard, understood their disease, had their emotions attended to, and was supported through the identity loss that illness can create. That reframing felt essential. If medicine defines efficiency only as speed, then listening will always look wasteful. If we define efficiency as trust, understanding, and partnership, then story becomes part of good care.

When I asked how writing and patienthood had changed her clinical practice, her answer was simple and total: it changed how she listens, how she sees, how she receives suffering, how she attends to it, what she values, and how she is present. That is what I hope narrative medicine can do at its best. Not decorate medicine with beautiful words, but alter the clinician’s posture toward the person in front of them.

Near the end of the conversation, she asked me what I had learned from my own interviews through Prose for Patients. I found myself thinking of the different kinds of stories I have been trusted with. Families in assisted living facilities trying to preserve a loved one before memory fades further. Hospital patients wanting clinicians to know who they are outside the room. Rare disease patients living in uncertainty for years, often asking not to be pitied but to be understood. Donor and recipient stories carrying grief, gratitude, and legacy in the same breath. Artists transforming illness into advocacy. Each group has taught me that there is no single patient story. There are only people, each trying to decide what illness has done to them and what it has not been able to take.

Dr. Awdish encouraged me to keep exploring this space and suggested that I consider submitting narrative work to medical journals that physicians actually read. That advice mattered because it reminded me that stories need audiences. A story held privately can be healing. A story shared with family can be a gift. A story used in education can change a learner. A story published in a clinical venue can reach the people who most need to rethink how they speak and listen.

I left the conversation with a clearer understanding of what Prose for Patients can become. It can be a space where participants feel seen and witnessed. It can be a bridge between patient experience and clinician education. It can support advocacy for communities whose stories are often ignored or misunderstood. It can explore the longitudinal nature of illness, returning to stories as people move through uncertainty, diagnosis, treatment, aftershock, adaptation, and meaning.

But most importantly, it must remain attentive to power.
The work is not simply to ask, “What is your story?” It is to ask: Who gets to tell it? Who gets to shape it? Who is it for? What does it change? Does it return something to the person who offered it? Does it help medicine listen differently?
Dr. Awdish’s lesson was that language is never neutral in medicine. It can close a door or open one. It can hoard power or return it. It can turn a patient into a body being acted upon, or it can invite them back into the center of their own care.
That is the kind of language Prose for Patients must try to practice.

Not language that speaks over people.
Language that gives something back.